Long Term Disability (ERISA or Private)
Many people obtain long-term disability benefit policies
their job or they purchase it on their own. These policies provide
financial benefits to people who become disabled either by accident
or illness. Most people expect the companies providing this insurance
to keep their promise and pay benefits if they become disabled. Unfortunately,
in many circumstances, this is not the case and policyholders learn
the hard way that a promise made can quickly turn into a promise broken.
Insurers are required to undertake a full and impartial claims review
of all disability benefit applications. Many insurers make little
or no effort to evaluate disability benefit claims. Often, they fail
to obtain critical medical records or job duty information before
issuing a denial. In addition, many insurers frustrate Claimants by
using complicated forms, making unreasonable documentation requests,
and/or requiring multiple examinations by "independent"
doctors who seemingly have little interest in doing a proper exam
and are centered on making findings to buttress an insurer's
predetermined denial of benefits. Long delays in "review"
are extremely common which become extremely frustrating to Claimants
who must wait months on end without any income assistance often to
receive bad news. During this process, Claimants often perceive the
process as futile and will fail to seek much needed legal assistance
in order to obtain benefits for their deserving claim.
If you take the time to review your disability policy, you will see
that it is a complex document filled with poorly defined terms.
Included in the policy language are many terms which must be satisfied
so as to qualify for coverage and other terms which seek to limit
coverage in many ways. Insurers will try to use various policy provisions
to limit benefit payments or avoid payment altogether. For these reasons,
a complete understanding of the policy terminology is essential to
making a benefits claim and interpreting a policyholder's potential
entitlements as limited under the same policy. In simpler terms, the
policies of insurance often giveth and taketh away simultaneously.
As a practical matter, it is important to seek the advice of an attorney
whenever a disability insurer begins tactics which seem burdensome, unusual,
. Often, effective assistance of counsel at the outset can prevent
many delays in claims processing which would otherwise occur due to a
Claimant’s lack of understanding of the claims process. Insurers rely on
the relative inexperience of Claimants in order to manipulate and delay
the claims process. Many times, there are administrative appeals available
to Claimants, which, if skillfully used, can lead to getting the claim
approved. If the appeals process is not used properly, this can lead to
an irreversible claims denial. Under no circumstance should a Claimant
pursue an appeal without legal counsel. Although it should go without
saying, a Claimant’s request for appeal without submitting documentation
proving disability under the policy terms. A Claimant’s blind reliance on
the insurer to "review" a denial by requesting an appeal without fully
documenting the disability claim is nothing less than an opportunity to
rubber stamp the original denial and force litigation.
In some cases, litigation will be necessary, even in cases, which the
disability is inarguable. Just because your treating physician writes
a report that states that you are disabled is no guarantee that you
will receive benefits. More often than not, the insurer’s in-house
physician will write a contrary finding, which will only be buttressed
by the examining "independent" physician hired by the insurer. When
receiving benefits is of drastic economic importance, it is amazing how
many Claimants fall prey to insurers and their empty promises of benefits
and false hopes of fair "appeals" within the disability benefit
application process. Often Claimants learn only too late that they
engaged in a game with dealer utilizing a "stacked" deck. This realization
often occurs at the same time that no assistance will be available from
their former employer or insurance broker originally responsible for
obtaining the policy of insurance.
801 Roeder Rd., Ste. 550 Silver Spring, MD 20910
Toll Free: 1-866-NEED-LTD (633-3583)